Of the many phases of life a woman moves through, she’s actually likely to spend the most time in postmenopause. Infancy, childhood, puberty, reproductive years, perimenopause, and menopause together make up approximately fifty years of life, so a healthy woman will spend between twenty and fifty years post-menopausal. While menopause does mark the ending of a woman’s reproductive years, it is also the beginning of a new, extended stage of life. Many women dread menopause and the years after, but armed with the right information and approach, life after menopause can be the most liberated of your life.
The whole Menopause Transition (MT) is spread over 20 years or more. Between the ages of 35 and 65, women are likely to suffer symptoms related to decreasing hormones associated with perimenopause, menopause, and postmenopause. The MT begins with perimenopause as estrogen, progesterone, and testosterone levels start to drop steadily.
Hormones are integral to many systems in the body and have a hand in the metabolism and healthy bones, teeth, brain, heart, eyes, skin, etc. Balancing declining hormones can promote and improve overall health regardless of what phase of the MT you are in.
A woman crosses the threshold of menopause once she has gone twelve months without a period, after which point she is technically in postmenopause. At this stage, some menopausal symptoms like hot flashes and night sweats may ease, but other symptoms may worsen1. This article will walk through the phases of the MT and identify how to make the journey as smooth and healthy as possible.
Perimenopause
Puberty is a time full of confusion and lots of fluctuations. It inducts us into womanhood, beginning menstruation and our reproductive years. As young women, we spend decades getting used to our monthly cycle, and then in the late 30s and early 40s, menstruation may start to shift from what we’ve come to know. At this stage, periods may become irregular - lighter, then heavier, then lighter again. Or periods may become more frequent than on an average 28-day cycle. This irregularity is an indicator of perimenopause.
Likely symptoms include vaginal dryness, uncharacteristic changes in mood, wrinkling skin, weight gain, and trouble sleeping. Other unwelcome physical and emotional changes during perimenopause can include thinning hair, vocal changes, depression, and even unusual body odor.
While we might’ve been taught that these symptoms are to be expected, and we have to live with them, actually addressing the underlying cause is the first step to lasting relief. Declining levels of hormones at this stage are responsible for the uncomfortable changes that occur and taking hormone replacement therapy (HRT) to normalize these hormones can help with many of the symptoms.
Menopause
Each woman is unique, and the experience in the MT is different for everyone. Some women breeze through menopause with few or minor symptoms. For others, this time is drastically challenging, with many symptoms or extremely severe ones. Whatever the case may be, there are some symptoms we can identify as the most common:
Hot flashes and night sweats: Sudden episodes of intense heat that raise skin temperature and cause flushing can occur during the day (hot flashes) or at night (night sweats). The body’s thermometer is affected by hormone imbalance, so HRT is the most effective way to reduce these incidents.
Mood swings: Depleting hormones affect the production of the critical mood-regulating neurotransmitter in the brain called dopamine. The misfiring of neurotransmitters can cause mood swings and mental health challenges like depression, anxiety attacks, and panic disorder.
Vaginal dryness and atrophy: As estrogen and testosterone decrease, so does the body's natural lubrication. Vaginal tissues will likely become drier, thinner, irritated, itchy, and less elastic. Sex can become less appealing and even painful.
The following symptoms are lesser-known but still common:
Brain fog: Forgetfulness, confusion, loss of focus, and difficulty concentrating fall under this category. Decreased estrogen and progesterone impact another hormone, cortisol, which is the “stress hormone.” When cortisol is not regulated, emotions can become erratic, and brain fog and slower cognitive skill function are common.
Thinning or loss of hair: While hair loss in men is related to testosterone, women suffer the same problem if estrogen and progesterone decrease and are not balanced with testosterone. Women might notice bald patches, thinning hair, and undesirable “peach fuzz.”
Urinary and bowel incontinence & frequent urination: The pelvic muscles weaken with age, pregnancy, and childbirth, and this is exacerbated by waning estrogen and testosterone. Replacing these hormones can minimize the frequency of accidents and/or bathroom visits.
Lowered libido: In postmenopause, women's bodies produce very little testosterone, the hormone that triggers sexual desire. Taking HRT with testosterone can revitalize the libido.
Change in body odor: This can be affected by various things, including urinary or fecal odors due to incontinence, pungent perspiration from hot flashes and night sweats, and a vaginal odor due to hormonal fluctuations affecting pH and lubrication.
Sleep problems: Dwindling hormones can trigger sleep disturbances like insomnia, waking up too early, or sleeping too long. Waking up with night sweats can also be disruptive. This kind of uneven sleep can lead to long-term health repercussions.
Joint, bone, and muscle aches: Aches and pains can be a part of getting older, and wear and tear of the joints don’t help. But as hormones drop with age, this can be amplified. Replenishing hormones can minimize inflammation and joint pain.
Weight gain: Estrogen and testosterone decrease prompt fat redistribution to the abdomen and back. This redistribution of fat is unhealthy and can lead to heart disease, stroke, diabetes, and some forms of cancer.
Headaches & migraines: Hormonal migraines may be a new experience for some women. These headaches often decrease or disappear after taking HRT.
Transitioning to Postmenopause
The average age for a woman to reach menopause is 51, but that varies within a wide range of 45-55. While not having to deal with your period or worry about getting pregnant can be liberating, the side effects of postmenopause symptoms can negatively impact your quality of life.
Some women notice a considerable lessening of symptoms once they hit postmenopause - especially hot flashes and mood swings. But other symptoms like painful sex, weight gain, vaginal dryness, incontinence, wrinkling skin, and brittle hair can worsen the further you get into postmenopause.
The common factor in all phases of the MT is that estrogen, testosterone, and progesterone levels steadily drop. If these hormones are not replenished with HRT, by the time a woman is in postmenopause, she can be at an increased risk of serious health conditions1, 2.
With the use of HRT, women can reduce the risk of these chronic medical problems:
Cardiovascular diseases (stroke, heart attack) are the #1 killer of women in the US. Menopause doesn't directly cause cardiovascular diseases, but it can increase your risk due to the shift in hormones and changes in blood pressure5, 8, 9.
Osteoporosis is sometimes called the silent killer. With the drop in hormones, bones become thinner, fragile, and more brittle, leading to fractures and breaks. Bone density may decrease by up to 25% following menopause up to age 603, 4.
Heart disease or coronary artery disease worsens with decreasing hormones and can lead to heart attacks.
Type 2 diabetes can be life-threatening. Disrupted hormonal balances can lead to chaos with blood sugar (glucose) levels, weight gain, and diabetes. Diabetes complications such as heart attack and stroke may follow.
Mental health disorders and Alzheimer's disease are more common as hormones are depleted.
Some types of cancer, including colon, esophageal, and uterine cancer can increase when estrogen and progesterone levels drop.
High cholesterol is common with waning hormones, which can boost harmful cholesterol and decrease good cholesterol, inviting a fatty buildup in the arteries. This can lead to stroke and heart attack5.
High blood pressure can be a result of menopause. Some think this is due to shifting hormones, while others think weight gain and an increase in body mass index in menopausal women is the cause.
Urinary health complications are often due to low hormones that lead to the lining of the urethra becoming dry, thin, and less elastic, which can increase the frequency of incontinence and urinary tract infections7, 8.
Supplementing hormone levels with HRT can help ease uncomfortable symptoms, reduce the risk of chronic health conditions, and allow you to enjoy a whole new level of freedom. Menstrual periods, menopause symptoms, and the resulting physical complaints can be a thing of the past.
In addition to HRT, there are simple lifestyle changes for alleviating menopause symptoms:
Exercising regularly can help regulate hot flashes and mood swings and reduce chronic stress.
Eating nutritiously will help support the body holistically, improving sleep and mood and reducing stress. In menopause, the body needs extra calcium and vitamin D. It’s also important to eat iron-rich foods, consume enough dietary fiber, and stay well hydrated.
Reducing the intake of caffeine and alcohol can help improve sleep quality, reduce hot flashes, relieve chronic stress, and avoid mood swings.
Mindfulness practices like meditation, yoga and deep breathing can help with chronic stress and stabilize your mood.
Avoiding triggers can help ward off hot flashes. These often include hot beverages, spicy foods, and alcohol. Dressing in layers is also a good idea, as is keeping a water bottle handy.
Conclusion
It takes many years to arrive at postmenopause, and reaching this juncture doesn’t necessarily mean that perimenopausal and menopausal symptoms automatically cease. But with HRT available to help replenish depleted hormones, there is hope for many years not only free from periods, but also from the symptoms you may have grown accustomed to in recent years. Postmenopause can be a hopeful beginning, with the opportunity to take preventive action against major health risks associated with decreasing hormones and explore life unencumbered.
At Winona, we encourage you to take this phase of your life seriously and pursue treatment to give you the relief and quality of life that you deserve. Our healthcare platform is a safe place to connect with your doctor, ask questions, and ultimately design a treatment plan that works for you.
